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HomeMy WebLinkAbout50516-Z r `-a TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ° SOUTHOLD, NY ,p BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 50516 Date: 4/5/2024 Permission is hereby granted to: Lombardi Wm R Irry Trust 2600 Eagles Lake Rd Virginia Beach VA 23456 To. construct additions and alterations to existing single-family dwelling as applied for per SCHD approval. At premises located at: 55 Pinewood Rd, Cutcho ue SCTM # 473889 Sec/Block/Lot# 110.-3-1 Pursuant to application dated 2/14/2024 and approved by the Building Inspector. To expire on 10/5/2025. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $996.00 CO-ADDITION TO DWELLING $100.00 Total: $1,096.00 Building Inspector µM TOWN OF SOUTHOLD -BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 M1 Telephone (631) 765-1802 Fax (631) 765-9502 littt)s://www.southoldtownnv.&,ov N . Date Received APPLICATION FOR BUILDING PERMIT d � LLii For Office Use Only PERMIT NO. Building Inspector. �mm Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: la/;Ly OWNER(S)OF PROPERTY: Name: :503E Pipit SCTM # 1000- 110 - g -I Project Address: 55 pilgeL x oD p-0 e4u-rGH0c uE • NY Phone#: 631 - 300 5450 Email: SosE . P, @yAr]oo com Mailing Address: 9a13 mlpptE Coun+Th po 0 CALuEQTanI • M • J1933 CONTACT PERSON: Name: 3., plEiQ Mailing Address: ,55 PiNEwaon gD • Cj1CM0&()E • n1y Phone#: 631 - 300 - 5 y5b Email: S05E . AMQ @ yAfto.cam DESIGN PROFESSIONAL INFORMATION: Name: DAu1D MAQT11vs - Pr&-" TEr--5 wo Mailing Address: IS MIOTOwN V eAP.LE PeAc- • NY •1151y Phone#: (;31 - 332 -3021 Email: dM[, Agt*IT£c.T.9 MAP•C0rn CONTRACTOR INFORMATION: Name: awe Pi2,r- Mailing Address: .55 P)NEW000 OD CulH06UE • my Phone#: G31 - sw -- SY5D Email: @yi4►aoo x-o n DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition RAlteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $_1456.850 iv)b Pooc. Will the lot be re-graded? ®Yes ❑No Will excess fill be removed from premises? Dyes ANo w z Tto 1 r PROPERTY INFORMATION Existing use of property: NAKLp PAiI Du)eujn:[-) Intended use of property: SIA GILF— FAMILy DWElurit, Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R_ NCB this property? ❑Yes ®No IF YES, PROVIDE A COPY. ® Check Box After Readilll1g: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized Inspectors on premises and In building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print name): �5W£ -Rl4AI ❑Authorized Agent ®Owner Signature of Applicant: ,; Date: STATE OF NEW YORK) COUNTY OFS 170C �-.�I w being duly sworn, deposes and says that (s)he is the applicant ( ame of individual signing contract)abovle named, (S)he is the �-ii.dar (Contractor, Agent,Corporate Officer,etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/Ijer knowledge and belief; and that the work will be performed in the manner set forth in the application file therewit ' Sworn before me this ST NOTARY PUB IC,STATE OF NEW YORK r NO.01 DA0012354 day of �—Q6(Ula( , 20 QUALIFIED,IN SUFFOLK COUNTY N ,2027 PROPER,,,I OWNER AUTI,,,,1 ) ) ) NIA (Where the applicant is not the owner) I, ` i residing at 21 C lJ a do hereby autho ' to apply on my behalf to the Town of Southold B rig Department for approval as described herein, sc kA eal 13 Qaaa Owner's Si Lire Date Print Owner's Name 2 IN Generated by REScheck-Web Software Compliance Certificate Project Pirir Residence Energy Code: 2018 IECC Location: Cutchogue, New York Construction Type: Single-family Project Type: Addition Climate Zone: 4 (5572 HDD) Permit Date: Permit Number: All Electric false Is Renewable false Solar Ready: false Has Charger false Has Battery: false Has Heat Pump: false Electric Ready: false Responsive Water Heating. false Construction Site: Owner/Agent: Designer/Contractor: 55 Pinewood Rd Jose Pirir David Martins Cutchogue, NY 11935 Architects MAD 18 Midtown Rd Carle Place, NY 11514 631-332-3021 dm@architectsmad.com Compliance: 14.8%Better Than Code Maximum UA: 189 Your UA: 161 Maximum SHGC: 0.40 Your SHGC: 0.29 The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. Slab on-grade.tradeoffs are no longer considered in the UA or performance co npliarice path in 11 IEScheck. Each slab-on-grade assembly in the specified chirnate zone must meant the miiinfinnurn energy code insulation IR value and depth reguiirernents. Envelage ; e Ie Gross Area Cavity Cont. Prop. Req. Prop. Req. Perimeter Ceiling: Flat Ceiling or Scissor Truss 740 38.0 0.0 0.030 0.026 22 19 Wall:Wood Frame, 16"D.C. 1,450 25.0 0.0 0.053 0.060 66 75 Door: Glass Door(over 50%glazing) 102 0.270 0.320 28 33 SHGC: 0.29 Window:Wood Frame 106 0.270 0.320 29 34 SHGC: 0.29 Floor:All-Wood joist/Truss 604 38.0 0.0 0.026 0.047 16 28 Project Title: Pirir Residence Report date: 03/25/24 Data filename: Page 1 of10 Compliance Statement: The proposed building design described here is consistent with the building plans,specifications, and other calculations submitted with the permit application.The proposed building has been designed to meet the 2018 IECC requirements in REScheck Version : REScheck-Web and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name-Title t.,rip" w� e Project Notes: Renovate existing one story wood frame dwelling. Finish existing garage and incorporate new kitchen, dining, and living room. Project Title: Pirir Residence Report date: 03/25/24 Data filename: Page 2 of10 a REScheck Software Version : REScheck-Web Inspection Checklist Energy Code: 2018 ICC Requirements: 0.0% were addressed directly in the REScheck software Text in the "Comments/Assumptions" column is provided by the user in the REScheck Requirements screen. For each requirement,the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. section Plans Verified Field Verified # Pre-Inspection/Plan Review Value Value Complies? Comments/Assumptions & Re .ID 103.1, Construction drawings and ❑Complies 103.2 'documentation demonstrate ❑Does Not [PR1]1 energy code compliance for the building envelope.Thermal ❑Not Observable envelope represented on ❑Not Applicable construction documents. 103.1, Construction drawings and ❑Complies 103.2, documentation demonstrate I❑Does Not 403.7 energy code compliance for [PR3]1 lighting and mechanical systems. ❑Not Observable Systems serving multiple ❑Not Applicable dwelling units must demonstrate compliance with the IECC Commercial Provisions. 302.1, Heating and cooling equipment is Heating.. Heating: ❑Complies 403.7 sized per ACCA Manual S based Btu/hr Btu/hr ❑Does Not [PR2]2 on loads calculated per ACCA Cooling: Cooling: ❑Not Observable tb Manual J or other methods Btu/hr Btu/hr_ _ ❑Not Applicable approved by the code official. pP Additional Comments/Assumptions: 11 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Pirir Residence Report date: 03/25/24 Data filename: Page 3 of10 Section # Foundation Inspection Complies? Comments/Assumptions &Re .ID 303.2.1 A protective covering is installed to ❑Complies [FO11]2 protect exposed exterior insulation ❑Does Not and extends a minimum of 6 in. below ❑Not Observable grade. ❑Not Applicable 403.9 ;Snow-and ice-melting system controls ❑Complies [FO12]2 installed. '❑Does Not ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 111 High Impact(Tier 1) J 2 1 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Pirir Residence Report date: 03/25/24 Data filename: Page 4 of10 Section Plans Verified Field Verified # Framing /Rough-In Inspection Value Value Complies? Comments/Assumptions & Re .ID 402.1.1, Glazing LI-factor(area-weighted U- U- ❑Complies See the Envelope Assemblies 402.3.1, average). ❑Does Not table for values. 402.3.3, ❑Not Observable 402.5 402.5 ❑Not Applicable 303.1.3 U-factors of fenestration products E]Complies [FR4]1 are determined in accordance ❑Does Not �„ with the NFRC test procedure or taken from the default table. ❑Not Observable +❑Not Applicable 402.4.1.1 IAir barrier and thermal barrier ❑Complies [FR23]1 installed per manufacturer's ❑Does Not instructions. ❑Not Observable ❑Not Applicable 402.4.3 Fenestration that is not site built ❑Complies [FR20]1 is listed and labeled as meeting 'DDoes Not AAMA/WDMA/CSA 101/I.S.2/A440 or has infiltration rates per NFRC ❑Not Observable 400 that do not exceed code ❑Not Applicable limits. 402.4.5 `IC-rated recessed lighting fixtures: ;❑Complies [FR16]2 sealed at housing/interior finish ❑Does Not and labeled to indicate 152.0 cfm leakage at 75 Pa. ❑Not Observable ❑Not Applicable 4033.1 Supply and return ducts in attics ❑Complies [FR12]1 insulated >= R-8 where duct is :❑Does Not >= 3 inches in diameter and >_ R-6 where < 3 inches. Supply and; - [-]Not Observable return ducts in other portions of ❑Not Applicable the building insulated >= R-6 for :diameter>= 3 inches and R-4.2 ; 'for< 3 inches in diameter. 403.3.2 Ducts, air handlers and filter ❑Complies [FR13]1 boxes are sealed with ❑Does Not !joints/seams compliant with International Mechanical Code or , ❑Not Observable International Residential Code, as` ❑Not Applicable !applicable. 403.3.5 'Building cavities are not used as ❑Complies [FR15]3 ducts or plenums, o❑Does Not []Not Observable ❑Not Applicable 403.4 HVAC piping conveying fluids R- R- ;❑Complies [FR17]2 above 105 9F or chilled fluids ❑Does Not below 55 9F are insulated to >_R- 3 ;[:]Not Observable ❑Not Applicable 403.4.1 :Protection of insulation on HVAC ❑Complies [FR24]1 piping. TIDoes Not , =❑Not Observable ❑Not Applicable 403.5.3 'Hot water pipes are insulated to R- R- ❑Complies [FR18]2 >_R-3. ❑Does Not I❑Not Observable r❑Not Applicable 403.6 Automatic or gravity dampers are; ❑Complies [FR19]2 'installed on all outdoor air ❑Does Not :intakes and exhausts. ❑Not Observable ❑Not Applicable 11 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Pirir Residence Report date: 03/25/24 Data filename: Page 5 of10 Additional Comments/Assumptions: 1 I High Impact(Tier 1) 2 (Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Pirir Residence Report date: 03/25/24 Data filename: Page 6 of10 section Plans Verified Field Verified # Insulation Inspection Value Value Complies? Comments/Assumptions & Re .ID 303.1 All installed insulation is labeled ❑Complies [IN13]2 or the installed R-values ❑Does Not provided. ,��� ❑Not Observable ❑Not Applicable 402.1.1, Floor insulation R-value. R R- ❑Complies See the Envelope Assemblies 402.2.6 ❑ Wood ❑ Wood ❑Does Not table for values. [IN1]1 ;❑ Steel ❑ Steel ❑Not Observable i ,❑Not Applicable ------------ 303.2, Floor insulation installed per ❑Complies 402.2.8 manufacturer's instructions and ❑Does Not [IN2]1 in substantial contact with the ❑Not Observable underside of the subfloor, or floor 'framing cavity insulation is in ❑Not Applicable contact with the top side of sheathing, or continuous insulation is installed on the underside of floor framing and extends from the bottom to the top of all perimeter floor framing members. 402.1.1, Wall insulation R-value. If this is a R- R- ❑Complies See the Envelope Assemblies 402.2.5, mass wall with at least Y,of the ❑ Wood ❑ woo ❑Does Not table for values. 402.2.6 wall insulation on the wall ❑ Mass ❑ Mass j❑Not Observable [IN3]1 exterior,the exterior insulation t , requirement applies (FR10). ❑ Steel ❑ Steel j❑Not Applicable 303.2 Wall insulation is installed per ❑Complies [I1\14]1 manufacturer's instructions. ❑Does Not ❑Not Observable !❑Not Applicable Additional Comments/Assumptions: 111 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 J Low Impact(Tier 3) Project Title: Pirir Residence Report date: 03/25/24 Data filename: Page 7 of10 Section Plans Verified Field Verified # Final Inspection Provisions Value Value Complies? Comments/Assumptions & Re .ID 402.1.1, Ceilinginsulation R-value. R- R- ' ❑Complies See the Envelope Assemblies ', 402.2.1, ❑ Wood ❑ Wood ❑Does Not table for values. �402.2.2, El Steel ❑ Steel j❑Not Observable 402.2.E[Fill' ❑Not Applicable 303.1.1.1, Ceiling insulation installed per ❑Complies 303.2 manufacturer's instructions. ❑Does Not [F12]1 Blown insulation marked every ❑ 1300 ft�. Not Observable _ ❑Not Applicable 402.2.3 ,Vented attics with air permeable ❑Complies [FI22]2 insulation include baffle adjacent ' ❑Does Not to soffit and eave vents that extends over insulation. ❑Not Observable ❑Not Applicable 402.2.4 (Attic access hatch and door R- R- ❑Complies [FI3]1 insulation >_R-value of the ❑Does Not adjacent assembly. ❑Not Observable ❑Not Applicable 402.4.1.2 Blower door test @ 50 Pa. <=5 ACH 50 = ACH 50 = ❑Complies [FI17]1 ach in Climate Zones 1-2, and ❑Does Not <=3 ach in Climate Zones 3-8. ❑Not Observable ❑Not Applicable 402.4.2 Wood-burning fireplaces have TIComplies [F18]2 tight fitting flue dampers and ❑Does Not outdoor air for combustion. ❑Not Observable ❑Not Applicable 403.3.3 Ducts are pressure tested to cfm/100 cfm/100 ❑Complies [F127]1 determine air leakage with ft2 ft2 ❑Does Not either: Rough-in test:Total leakage measured with a ❑Not Observable pressure differential of 0.1 inch ❑Not Applicable w.g. across the system including ;the manufacturer's air handler :enclosure if installed at time of test. Postconstruction test:Total ,leakage measured with a I pressure differential of 0.1 inch w.g. across the entire system including the manufacturer's air handler enclosure. 403.3.4 'Duct tightness test result of<=4 cfm/100 cfm/100 ❑Complies [FI4]1 cfm/100 ft2 across the system or ft2 ft2 ❑Does Not <=3 cfm/100 ft2 without air handler @ 25 Pa. For rough-in ❑Not Observable 'tests, verification may need to ❑Not Applicable occur during Framing Inspection. 403.3.2.1 Air handler leakage designated :❑Complies [F124]1 by manufacturer at<=2%of ❑Does Not design air flow. ❑Not Observable ❑Not Applicable 403.1.1 Programmable thermostats ❑Complies [Flg]z installed for control of primary ❑Does Not heating and cooling systems and initially set by manufacturer to ❑Not Observable code specifications. ❑Not Applicable 403.1.2 'Heat pump thermostat installed E] omplies [FI10]2 on heat pumps. ❑Does Not "E]Not Observable ❑Not Applicable 11 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Pirir Residence Report date: 03/25/24 Data filename: Page 8 of10 section Plans Verified Field Verified # Final Inspection Provisions Value Value Complies? Comments/Assumptions & Re .ID 403.5.1 ;Circulating service hot water ❑Complies [FI11]2 `systems have automatic or ❑Does Not accessible manual controls. `❑Not Observable ❑Not Applicable 403.6.1 All mechanical ventilation system ❑Complies [F125]2 fans not part of tested and listed `❑Does Not HVAC equipment meet efficacy and air flow limits per Table ❑Not Observable ❑ R403.6.1. Not Applicable 403.2 Hot water boilers supplying heat ❑Complies [FI26]2 through one-or two-pipe heating - ❑Does Not ,systems have outdoor setback control to lower boiler water ❑Not Observable temperature based on outdoor ❑Not Applicable i temperature. 403.5.1.1 Heated water circulation systems ' ❑Complies [FI28]2 have a circulation pump.The ❑Does Not system return pipe is a dedicated return pipe or a cold water supply ❑Not Observable pipe. Gravity and thermos- ❑Not Applicable ;syphon circulation systems are not present. Controls for circulating hot water system pumps start the pump with signal ,for hot water demand within the occupancy. Controls automatically turn off the pump ,when water is in circulation loop is at set-point temperature and no demand for hot water exists. i403.5.1.2 Electric heat trace systems ❑Complies [F129]2 'comply with IEEE 515.1 or UL ❑Does Not 515. Controls automatically adjust the energy input to the ❑Not Observable heat tracing to maintain the ❑Not Applicable desired water temperature in the piping 403.5.2 'Demand recirculation water ❑Complies [F130]2 systems have controls that ❑Does Not manage operation of the pump and limit the temperature of the ❑Not Observable water entering the cold water ❑Not Applicable ;piping to<= 104°F. 403.5.4 Drain water heat recovery units ❑Complies [F131]2 tested in accordance with CSA TIDoes Not i B55.1. Potable water-side pressure loss of drain water heat '[-]Not Observable recovery units < 3 psi for ❑Not Applicable individual units connected to one or two showers. Potable water- side pressure loss of drain water heat recovery units < 2 psi for individual units connected to three or more showers. 403.10.1 Readily accessible switch on ❑Complies [F112]3 heaters for swimming pools or ❑Does Not permanent in-ground spas. Switch operation does not [-]Not Observable change heater thermostat ❑Not Applicable setting. Heater circuit breaker is installed independent of switch. Gas-fired heaters equipped with ignition pilots that are not ;continuously burning pilots. 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Pirir Residence Report date: 03/25/24 Data filename: Page 9 of10 section Plains Verified' Field verified Final Inspection Provisions Value Value Complies' Comments/Assumptions ate .ID 403,10.2 ;Timer switches or other []Complies [F11913 automatic preset schedule ❑Does Not control method are installed on heaters and pumps serving pools !❑Not Observable ❑ and permanent Not Applicable 403.10.3 Outdoor heated pools and ❑complies [,F120]3 outdoor permanent spas have a ❑Does Not ;vapor retardant cover. ;❑Not Observable ;❑Not Applicable 404.1 90%or more of permanent ❑Complie [FI6]1 Mixtures have high efficacy lamps, ;❑Does Not ;❑Not Observable ❑Not Applicable 404.1.1 Fuel gas lighting systems have ❑Complies [F123]3 no continuous pilot light. ❑Does Not 4 ❑Not Observable `❑Not Applicable 401,E Compliance certificate posted. ❑Complies [F17]2 �❑Does Not ❑Not Observable ❑Not Applicable 303.3 Manufacturer manuals for []Complies [FII18]5 mechanical and water heating []Does.Not systems have been provided. ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 111 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low lmpatt(Tier 3) Project Title: Pirir Residence Report date: 03/25/24 Data filename: Page 10 of10 a, Efficlency Certificate IN Above-Grade Wall 25.00 Below-Grade Wall 0.00 Floor 38.00 Ceiling / Roof 38.00 Ductwork (unconditioned spaces): Window 0.27 0.29 Door 0.27 0.29 Heating System: Cooling System: Water Heater: ill Name: Date: Comments Ate`R .- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND DER,THIS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,.THIS BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN ER THE OTHE RISSUING NSU ER(S ,AHE UTHORIZES REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ) AUTHORIZED IMPORTANT NTT If the certificate holden to the s an etrms and conditionDs°the pof the plicy(ies)must have ADDIT'I'ONAL IIUSUlTI D provisions or be endorsed. If SUBROGATION IS WAIVED subjec this certificate does not confer ri I1ts to the certificate holder in lieu of suchlendo se nenpt((Islcies may require an endorsement. A statement on PRODUCER ACT Aspen Agency Inc NAW Lisa Marie 191 Ronkonkoma Ave PHONEzF om.z 631-4471-7575rz- � m Ronkonkoma, NY 11779 A lisa@as�aen ny. m IT " `N ��631 3119 2439„ INSURER AI^FORDING COVERAGE — INSURER A; Wean _ NAIL#INSURED... I can Euro +Ban Irlsura;. CO Pirir Construction Corp INSURER 11 4213 MIDDLE COUNTRY RD INSURER C Cal'verton, NY 11933 INSURER 0 -- IdN;SURERE: COVERAGES IFICATE INSURERF: — .. S is 47-614095 IIIIOI CATEO CN WI7HSTANDgNPGOAhIYE EOM INSURANCE NU METED BELOW HAVE BEEN ISSUED TO THE YN UREi9 NAREVIS MED A�'ON NUMBER: 26 UIREM NT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITHERES PECT TOLWHICH R IS CERTIFICATE EXCLUSIONS STE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IT+k^a R �. Lyn TYPE OF INSURANCE AD L S BR A POLICY NUMBER POLICY EFF PO'7ICV EI6 COMMERCIAL GENERAL LIABILITY 12/13/2 YYY MMIDDIYYYY LIMITS M D CO CPP 0011604 10 023 12/13/2024 EACH CLAIMS-MADE �OCCUR I $ 1000000 $ _ 101090 MED EXP IAn one Iporscn) S 5 000 GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ 1 0000,00 POLICY PRO- JECT LOC GENERALAGGRFGATE $ 20000,00 OTHER; PRODUCTS-COMP/OP AGG $ 000 000 AUTOMOBILE LIABILITY $ ANY AUTO C e E SINGLE L Mi $ OWNED ^gy SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY „AUTOS HIRED AUTOS ONLY y NON-OWNED BODILY INJURY(Per accident) $ — AUTOS ONLY ._FE RT Y m.._ I'RCiPIcY DAMAGE Ora is ent $ UMBRELLA LIAB „w OCCUR EXCESS LIAB CLAIMS,-MADE EACH OCCURRENCE $ OEIS RETENTION S AGGREGATE $ WORKERS COMPENSATION AND EMPLOYERS"LIABILITY $ ANY PRO R EIETO ARTNE EXECUTWE YIN PTR 0 H EXCLUDED? N/A .,E..L.EACH mm __' _.._.,....�...... ., ..(Mandatory in NH) E� AL.CIDENT �,- II yea,describe under _ _ ...._._. _. _..... DESCRIPTION OF OPERATIONS below L.DISEASE EA EMPLOYE E. E.L,DISEASE POLICY LIMIT +$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLl71ER CANCELLATION' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE VILLAGE OF SOUTHAMPTON THE EXPIRATION DATE THEREOF„NOTICE WILL BE DELIVERED IN 23 MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS Southampton, NY 11968 AUTHORIZE EPRESENTATIVI~' ACORD 25(2016/03) ©1988-2015 ACORD C'O'RPORATIdN, All rights rese vI d. The ACORD name and logo are registered marks of ACORD Printed by LIS on 01/09/2024 at 11:10AM NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE "^""^^ 473963558 ASPEN AGENCY INC 191 RONKONKOMA AVE RONKONKOMA NY 11779 SCAN TO VALIDATE POLICYHOLDER AND SUBSCRIBE PIRIR CONSTRUCTION CORP FMAIN HOLDER 4213 MIDDLE COUNTRY RD SOUTHAMPTON CALVERTON NY 1193S9I}5 TON NY 11968 POLICY NUMBER CERTIFICATE NUMBER 12405 340-7 112387 POLICY PERIOD E A DT 12/13/2023 TO 12/13/2024 1/09 024 THISSTATE INSUNCE IS TO CERTIFY POLICY A T E PO ICYHOLDER NAMED ABOVE05 ENTIRE UOBLLI WITH IGATION HOF I�THISE NW ORK POLICYHOLDER FOR WORKERS COMPENSATION UNDER THE NEW YORK WORKERS" COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW„ AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK„ TO THE, POLICYHOLDER'S REGULAR NEW YORK STATE. EMPLOYEES ONLY, IOR TO VALIDATE THIS F YOU"NI4IISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, YORK STATE INSURANCE FUND ISEN�OT LIABLE IN VISIT OUR ETHE EVENT OF FAILURE TO GIVEISITE AT E SUCHTNOTIFICATI N THE NEW E SUCH NOTIFICATIONS, THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE'. INSURED CORPORATION PRESIDENT JOSE P PIRIR COTZOJAY PIRIR CONSTRUCTION CORP (ONE PERSON CORP) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND �/4 4 U-26.3 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 829329090 Suffolk Counter Crept. of Labor, g Licensin Consum er Affairs HOME IMPROVEMENT LICENSE p iu I p ul(pupil�ll iimia, Name JOSE P PIRIR Business fame s certifies that :he ,rer is duly licensed Pirir Construction Corp �-e Courty of suffolk License Number: HI-66426 Rosalie Drago Issued: 03110F2022 Comn-iss over Expires: 03/0112024 i a s Town Hall Annex Telephone(631)765_1802 54375 Main Road Fax(631)765 9502 P. O. Box 1179 Lp Southold, NY 11971-0959 y 0 BUILDING DEPARTMENT NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION PRE-ENGINEERED WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION Date: Owner: Soso Piet?- Location of Property: 56 PaArora e ow rCt t9k►"�NIt N Please take notice that the (check applicable line): New commercial or residential structure Addition to existing commercial or residential structure X Rehabilitation to an existing commercial or residential structure to be constructed or performed at the subject property reference above will utilize (check applicable line): Truss type construction (TT) X Pre-engineered wood construction (PW) Timber construction (TC) in the following location(s) (check applicable line): Floor framing, including girders and beams (F) Roof framing (R) Floor and roof framing (FR) Signature: Name (person submitting this form): DAutD M IZTI 2 pi>fcT Capacity(check applicable line): Owner Owner representative TrussReg15.docx Effective 1/1/2015 o v N io II Ci CD m In CD m Na� m 0a 0 z CD �m r m o O r� c g - v < 3 O tZn � �i o C,J7 'a�M�`�qaa _ fay a`° or o D rt to N.+ CDobi CA o m=n omo C cco ar"BF� , a d N m D pIn oo 5 _Z D m O � En -14 'EnOZZ N CW Z o �0< Np� D m t0 t14 a W � ; m D m <O p T t7 l Z< zZ O DC2 o < OT.K 9;)e O + t y ' e ' f* "1 s ZD.00 O � O %% O? � �� Oo 6 ' m Cp O.y rri z co V-2i "y ..n �.: �ha• " " "'�! i10 1 C � LeoPa c. 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